URINARY OBSTRUCTION Urinary obstruction can be a presentation of benign or a serious condition. Obstruction can occur anywhere in the urinary tract: Kidneys, ureter (the tube between the kidney and the bladder), bladder, prostate (in men), urethra (the tube between the bladder and the outside) Signs and symptoms of urinary obstruction inability to pass urine (urinary retention) weak stream of urine interrupted stream blood in the urine pain in either flank (side) or in the back abdominal pain and/or swelling

URINARY STASIS 1. a stoppage or diminution of flow, as of blood or other body fluid. 2. a state of equilibrium among opposing forces.stat´ic urinary stasis stoppage of the flow or discharge of urine, at any level of the urinary tract. may be caused by abnormalities in structure or innervation of the urinary outflow tract that result in incomplete emptying of the bladder or pooling of urine in diverticula. Important in the etiology of cystitis.

Damage on renal functionOBSTRUCTIONHYDRONEPHROSISSTASISinfection

CLASSIFICTION CAUSE congenitalacquired DURATION acutechronic DEGREE partialcomplete LEVEL Lower urinary tract Upper urinary tract

CONGENITAL Common sites of obstruction – External meatus in boys  meatal stenosis – Inside external meatus in girls – Distal urethra  stenosis – Posterior urethral valves – Ectopic ureters – Ureterocoele – Uteropelvic junction Damage to S2 – S4 roots (spina bifida and myelomeningocoele) – Causes urinary stasis

External meatus in boys  meatal stenosis

B A A. Distal urethral stenosis B. Mild dilatation of proximal urethra

NEWBORN CIRCUMCISION Removal of the foreskin, a flap of skin that covers the tip of the penis.

B A C A. Posterior urethra (no veru or prostatic impression) B. Reflux into both ureters C. Weak stream PRUNE BELLY SYNDROME

ECTOPIC URETERS

URETEROCOELE

URETEROPELVIC JUNCTION OBSTRUCTION

ACQUIRED Primary or Secondary to retroperitoneal lesion that invade or compress the urinary passages – Urethral strictures secondary to infection or injury – Benign prostatic hyperplasia or prostatic CA – Vesical tumor involving the bladder neck or one or both ureteral orifices – Local extension of CA of prostate or cervix into the base of bladder occluding the ureters – Compression of the ureters at the pelvic brim by metastatic nodes from CA of prostate or cervix – Retroperitoneal fibrosis or malignant tumor – pregnancy Neurogenic dysfunction  affects bladder Infection secondary to ureterovesical obstruction Severe constipation  bilateral hydroureteronephrosis Elongation and kinking of the ureter secondary to vesicoureteral reflux

URETHRAL STRICTURE

HIDE!

BENIGN PROSTATIC HYPERPLASIA

PROSTATIC CA Possible signs of prostate cancer include a weak flow of urine or frequent urination.  Weak or interrupted flow of urine.  Frequent urination (especially at night).  Trouble urinating.  Pain or burning during urination. Blood in the urine or semen.  A pain in the back, hips, or pelvis that doesn't go away.  Painful ejaculation.

DIAGNOSIS DRE PSA ULTRASOUND BIOPSY TRANSPERINEAL BIOPSY ULTRASOUND DRE

58 year old man with abdominal pain, four months following surgery for retroperitoneal fibrosis RETROPERITONEAL FIBROSIS Causes Its association with various immune-related conditions and response to immunosuppression have led to speculations as to the autoimmune etiology of idiopathic RPF. One-third of the cases are secondary to:  malignancy  medication (methysergide, hydralazine, beta blockers)  aortic aneurysm  certain infections.

Copyright © 2007 by the American Roentgen Ray Society Blandino, A. et al. Am. J. Roentgenol. 2002;179: year-old man with neoplastic retroperitoneal fibrosis due to colon carcinoma